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改良按需喂养和腹部按摩对早产儿喂养效果的临床研究

Clinical research on feeding effect of semi-demand feeding and abdominal massage in preterm infants

摘要:

目的:评价改良按需喂养和腹部按摩对早产儿喂养进程、喂养表现及临床安全性(包括恢复出生体质量时间、喂养耐受性、呼吸暂停)的影响。方法将120例符合纳入标准的早产儿作为研究对象,采用随机数字表法将其分成3组,每组各40例。对照组接受早产儿常规喂养护理;改良按需喂养组在常规喂养护理基础上,于每次喂养前给予5~10 min的口腔功能训练(包括口腔刺激和非营养性吸吮),而后根据其意识行为状态决定喂养方式;改良按需喂养联合腹部按摩组在常规喂养护理及改良按需喂养基础上,每次喂养前增加腹部按摩100次。观察并记录3组在经口喂养过渡时间、喂养表现及临床安全性方面是否存在统计学差异。结果在喂养过渡时间方面,3组天数分别为(11.55±4.69)、(10.98±3.85)、(8.50±3.87)d,差异有统计学意义(F=6.088,P=0.003)。3组在喂养表现方面,喂养效率分别为(7.27±2.65)、(9.74±2.63)、(9.52±2.13)ml/min;喂养成效分别为(66.31±14.51)、(76.64±12.46)、(82.26±10.65)%;喂养奶量比分别为(63.99±11.02)、(80.16±14.41)、(84.97±11.16)%,差异均有统计学意义(F=12.189、16.383、31.959,均P<0.01)。在临床安全性当中,恢复出生体质量方面,3组所需时间分别为(10.55±1.99)、(9.28±1.77)、(10.05±2.46)d,差异有统计学意义(F=3.759,P=0.026);喂养不耐受3组发生率分别为50.0%(20/40)、40.0%(16/40)、22.5%(9/40),差异有统计学意义(χ2=6.613,P=0.037);呼吸暂停3组发生率分别为37.5%(15/40)、20.0%(8/40)、15.0%(6/40),差异有统计学意义(χ2=6.093,P=0.048)。结论改良按需喂养联合腹部按摩在改善喂养表现的基础上,进一步缩短喂养过渡时间,提高临床安全性,建议临床推广使用。

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abstracts:

Objective To evaluate the feeding effect of semi-demand feeding and abdominal massage on the feeding process, feeding performances and clinical safety (including the time of returning to birth weight, feeding tolerance, apnea). Methods A total of 120 preterm infants that met inclusion criteria of the study were randomly assigned to three groups, and each group had 40 cases. Control group:received standard feeding care. Semi-demand feeding group: received 5-10 minutes of oral motor intervention every time before feeding(including oral stimulation and non nutritional sucking), then decided feeding methods according to its consciousness behavior state. Semi-demand feeding combined abdominal massage group: received both semi-demand feeding and abdominal massage before feeding. Observed and recorded the three groups′ transition time, whether there were statistically significant differences in feeding performance and clinical safety. Results The feeding transition time was (11.55± 4.69), (10.98±3.85), (8.50±3.87)d in control group, semi-demand feeding group and semi-demand feeding&nbsp;combined abdominal massage group, and there were significant differences (F=6.088, P=0.003). In terms of feeding performance, the feeding efficiency were (7.27 ± 2.65), (9.74 ± 2.63), (9.52 ± 2.13) ml/min, the feeding proficiency were (66.31 ± 14.51)%, (76.64 ± 12.46)%, (82.26 ± 10.65)%, the volume transfer were (63.99 ± 11.02)%, (80.16 ± 14.41)%, (84.97 ± 11.16)% in control group, semi-demand feeding group and semi-demand feeding combined abdominal massage group, and there were significant differences (F=12.189, 16.383, 31.959, all P < 0.01).Among the clinical safety, the time of restoration of birth weight were (10.55 ± 1.99), (9.28 ± 1.77), (10.05 ± 2.46) d in control group, semi-demand feeding group and semi-demand feeding combined abdominal massage group, and there were significant differences(F=3.759, P=0.026). The incidence of feeding intolerance were 50.0%(20/40), 40.0%(16/40), 22.5%(9/40), and there were significant differences(χ2=6.613, P=0.037). The incidence of apnea were 37.5%(15/40), 20.0%(8/40), 15.0%(6/40), and there were significant differences(χ2=6.093, P=0.048). Conclusions The combined intervention methods could accelerate the feeding process, improve feeding performance as well as reduce the incidence of feeding intolerance and apnea. Hence, semi-demand feeding combined abdominal massage is a recommended choice for clinical use.

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